Sunday, 27 December 2009

The patient is a 56 year old male with a chief complaint of chest pain.

Onset: Approximately 30 minutes prior to EMS arrivalProvoke: Nothing makes the pain better or worseQuality: Described as intense pressureRadiate: The pain does not radiate to the arms, back, neck, or jawSeverity: 6/10Time: Unknown whether the patient has experienced previous similar episodes

The patient denies shortness of breath.

The patient's skin is pink, warm, and dry.

Past medical history is significant for cardiac stent 2 years prior.

Medications: unknown.

Vital signs are assessed:

Resp: 18Pulse: 1ooBP: 160/90SpO2: 97 on RA

A 12-lead ECG is captured.

The patient is loaded for transport.

An additional 12-lead ECG is captured en route to the local non-PCI hospital.

Of particular interest to me, in the absence of an obvious STEMI, this paramedic's EMS system allows bypass to a STEMI center when 2 of 5 secondary criteria are present.

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This blog is a attempt to bring the subject of ECG to the hearts of all you clinicians and students, with a aliment of fun in working out the clinical relevance, abnormalities. See if you are up for the challenge of the cause of the arrhythmia, its clinical significance, differential diagnosis and the practical aspects of patient management.